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Welfare Reform on the Web (October 2009): National Health Service - reform - general

Back to what future?

N. Plumridge

Public Finance, July 10th-16th 2009, p. 20-21

The author identifies the main strands of Conservative Party health policy. These comprise:

  • Putting an end to an alleged culture of top-down control and management by targets, and establishing patient outcomes as success criteria
  • Proposals for a return to GP fundholding
  • Pledges to promote patient choice, covering choice of hospital, choice of doctor, individual budgets for people with long-term conditions, and access to single rooms in NHS hospitals
  • Support for operational independence for the NHS, including the creation of an independent board and a constitution
  • Support for all current NHS trusts and the provider arms of primary care trusts to attain foundation status.

Beyond the fringe benefits

A. Moore

Health Service Journal, Sept. 3rd 2009, p. 22-24

Due to upcoming budget cuts, NHS employers will be looking for savings on staff costs, but will be keen to avoid laying off frontline staff. Scope for cutting wages is limited, so perks such as cheap staff car parking and workplace nurseries could be targeted for cuts. As the NHS budget is fixed until 2011, trusts have time to prepare and to find new ways of working.

A budget too far?

M. Hunter

Community Care, Sept. 10th 2009, p. 26-27

The Health Bill currently before Parliament will legalise direct payments in healthcare, paving the way for 70 pilot projects which will test the use of personal health budgets as a way of giving NHS patients greater choice and control over the services they receive. It is at present unclear how personalised health budgets will work and how they will affect the interface between health and social care.

Clamour grows for heroin on the NHS

J. Laurance

The Independent, Sept. 14th 2009, p. 1 & 2

A group of government-appointed drug experts is planning to call for a nationwide network of 'shooting galleries' to provide injectable heroin for hardened drug addicts across the country. A pioneering trial programme prescribing heroin to long-term addicts, which was started three years ago, has shown 'major benefits in cutting crime and reducing street sales of drugs. The programme was modelled on one in Switzerland and similar clinics have also been established in France, Germany and Canada. Critics say giving addicts the drugs they were previously scoring on the streets is not 'treatment' and at 15,000 a year per head cannot be justified but addiction experts say it is about 'harm reduction', not cure.

Control delete: a local future for IT

D. West

Health Service Journal, Aug. 27th 2009, p. 10-11

The Department of Health is turning away from a national centrally procured IT programme for the whole NHS, allowing trusts to develop local solutions and a range of private providers to move in. The Conservatives have announced their intention to take this process further, renegotiating national contracts and asking trusts to pick from an open 'catalogue' of IT systems that can communicate with each other.

Drug blunders on NHS 'may affect 860,000 patients'

K. Devlin

Daily Telegraph, Sept. 4th 2009, p. 8

The National Patient safety Agency has reported that medication errors jumped from 36,335 in 2005 to 86,085 in 2007. The agency believes that only 10% of mistakes are reported, suggesting that the true number of errors could be as high as 860,000 every year. However, 96% of reported mistakes result in little or no harm to patients.

Emergency admissions and hospital beds

R. Jones

British Journal of Healthcare Management, vol. 15, 2009, p. 289-296

The acute bed crisis in the Winter of 2008/09 and the ongoing maternity bed crisis suggest that there may be room for improvement in planning for the availability of beds for unscheduled and emergency care. This article discusses the issues of bed planning for emergency admissions in the light of the annual summer/winter and long-term cycles. The impact of changing to single sex wards and the provision for zero day stay admissions is also discussed. It concludes that the method currently used to forecast the number of beds required for emergency admissions is flawed and underestimates the real needs.

Mid Staffs means a new outlook for regulators

D. West

Health Service Journal, Sept. 3rd 2009, p. 10-11

The appalling care standards at Mid Staffordshire Foundation Trust, revealed in a Healthcare Commission report in March 2009, raised questions over the regulator Monitor's ability to ensure patients are safe in foundation trust hospitals. The regulator has attempted to allay concerns by proposing radical changes to how quality of care is managed. It proposes that:

  1. its relationship with the Care Quality Commission and their respective roles should be clarified
  2. a new 'quality bar' for the authorisation of foundation trusts should be agreed
  3. its regulation of clinical governance at board level should be improved
  4. external audit of quality accounts should be introduced in 2010.

The new sociology of the health service

J. Gabe and M. Calnan (editors)

London: Routledge, 2009

Health service policy and health policy have changed considerably over the past fifteen years and there is a pressing need for an up-to-date sociological analysis of health policy. Not only have policies themselves changed but new policy themes - such as evidence-based policy and practice, an increasing focus on a primary care led health service, a growing recognition of the need to address inequalities through public health policies and a focus on the views and the voice of the user and the public- have emerged alongside some of the old. This all-new volume follows up The Sociology of the Health Service, and covers a broad range of key contemporary health services issues. It includes chapters on consumerism, technology, evidence-based practice, public health, managerialism and social care among others, and incorporates references to new developments, such as regulation and incentivization.

Parliament set to battle over Monitor and autonomy of foundation trusts

D. West

Health Service Journal, Sept. 17th 2009, p. 4-5

In response to the Mid Staffordshire Foundation Trust scandal, health secretary Andy Burnham put forward proposals that would allow ministers to ask regulator Monitor to intervene and strip a trust of foundation status. The Conservatives have vowed to fight the plans which will be introduced to the Commons in the Health Bill on October 12th 2009.

Sentenced to death on the NHS

K. Devlin

Daily Telegraph, Sept. 3rd 2009, p. 1+ 2, 23

In a letter to the Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged to be close to death. They are then put on the Liverpool Care Pathway, a scheme approved by the National Institute for Clinical Excellence in 2004. This allows medical staff to hasten death by withdrawing fluids and drugs and sedating patients until they pass away. However, this approach can mask signs of improvement and the original diagnosis can be wrong.

Tick-box rules 'will lead to rise in assisted suicides'

C. Hope and K. Devlin

Daily Telegraph, Sept. 24th 2009, p. 1 + 4

There is concern that the number of assisted suicides of seriously ill people could rise because of new guidelines published to help lawyers decide whether relatives should be prosecuted for helping a family member to die. The guidance has been criticised for giving the 'green light' for families to opt to help their sick relatives commit suicide, free from fear of prosecution. Britain could replace Switzerland as the world suicide capital.

(See also Daily Telegraph, Sept. 23rd 2009, p. 1 + 2)

Using emergency theatre facilities

S. Metcalfe and J.F. Cosgrove

British Journal of Healthcare Management, vol. 15, 2009, p. 276-282

National guidelines exist for optimal provision of emergency theatre services. This article presents a case study of how the Freeman Hospital, a tertiary referral centre in Newcastle, has used regular audit and monitoring to identify problems and then implement interventions which have culminated in sustained service improvements, ie reduced waiting times for emergency surgery, increased senior anaesthetist input, and reduced delays.

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